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Your liver quietly filters toxins from the bloodstream and performs other key functions to keep you alive. Yet this vital organ can be vulnerable to disease that goes undetected until it becomes serious. About 42,000 new cases of liver cancer will be diagnosed this year, and many people may be living with risk factors they don’t know they have.

“Liver cancer is one of the few cancers where prevention and surveillance can truly save lives,” says Augusto Villanueva Rodriguez, MD, PhD, a hepatologist and medical director of the Liver Tumor Program at ���ϸ����� Langone’s Perlmutter Cancer Center.

Here, Dr. Villanueva Rodriguez shares five things you may not know about liver cancer—and what you can do to reduce your risk.

1. Liver Cancer Has No Early Warning Signs 

Unlike other cancers that may cause pain or fatigue early on, liver cancer can progress quietly for years.

“Patients can have large tumors without symptoms,” Dr. Villanueva Rodriguez explains. “When symptoms like jaundice, abdominal swelling, or extreme fatigue do appear, it’s often because the disease is at an advanced stage. That’s why it’s so important to understand liver cancer’s main risk factors and take action before it starts.”

2. Every Adult Should Be Tested for Hepatitis, a Key Risk Factor

“Infection with hepatitis B or hepatitis C is a major risk factor for developing liver cancer,” says Dr. Villanueva Rodriguez. “Yet like liver cancer itself, these conditions often have no symptoms. That’s why universal screening is so important—because people living with chronic hepatitis may not even be aware they are at risk.” may not even be aware they are at risk.”

Until recently, only people at higher risk of these infections, such as healthcare workers and pregnant women, were advised to get tested. Now, the Centers for Disease Control and Prevention (CDC) recommends that every adult over the age of 18 get tested for both conditions at least once in their lifetime. Ongoing testing is recommended for those at higher risk, including people who have used injected drugs and shared needles.

3. Liver Cirrhosis and Liver Cancer Go Hand in Hand

Most cases of liver cancer develop in people who already have cirrhosis, or scarring of the liver. Causes include viral hepatitis, alcohol use disorder, and metabolic dysfunction–associated steatotic liver disease (MASLD, formerly known as nonalcoholic fatty liver disease), common in people living with excess weight or obesity.

The risk of liver cancer in people with cirrhosis is between 2 and 3 percent each year, which makes ongoing surveillance important. Our experts recommend that people with cirrhosis have a liver ultrasound and a blood test for alpha-fetoprotein, which can mark the presence of cancer cells, every six months.

“There is a lot of stigma around cirrhosis and liver disease in general, as it can be associated with alcohol or drug use and sexual activity, which is a risk factor for hepatitis,” notes Dr. Villanueva Rodriguez. “The stigma often means people don’t get tested, which is unfortunate when there are steps we can take to help people reduce their risks.”

4. Liver Cancer’s Main Risk Factors are Treatable

One of the most encouraging facts about liver cancer is that its main risk factors can be treated—or even reversed.

“Hepatitis B can be prevented with a vaccine, and hepatitis C can now be cured in almost all cases,” says Dr. Villanueva Rodriguez. “Alcohol-related liver disease can improve when drinking is controlled, and fatty liver disease can regress with weight loss, better nutrition, and control of metabolic conditions like diabetes.”

Addressing these underlying risk factors early doesn’t just protect the liver—it’s one of the most effective cancer-prevention strategies we have. “When we manage these risks, we can dramatically lower the odds of developing liver cancer at all,” Dr. Villanueva Rodriguez notes.

5. Treatment for Liver Cancer Has Come a Long Way

In the past, liver cancer was considered difficult to treat once diagnosed. But in the last decade, targeted therapies and immunotherapy have transformed care—and outcomes.

“We now have therapies that stimulate the body’s own immune system to recognize and fight a tumor, and others that specifically target the genetic factors that drive cancer growth,” Dr. Villanueva Rodriguez explains.

At ���ϸ����� Langone, specialists use a team-based approach to determine the best options for each patient, often combining treatments to extend and improve quality of life. “We’ve reached a point where even patients with advanced disease have more possibilities than ever before,” he adds.

Have Risk Factors for Liver Cancer? When to Talk to a Doctor

Because liver cancer is silent, awareness and prevention are everything. Dr. Villanueva Rodriguez recommends talking with a healthcare provider about liver cancer screening if any of these risk factors apply:

• You have a history of hepatitis B or C, or haven’t been tested for these conditions as an adult.
• You have been told you have cirrhosis or fatty liver disease.
• You drink alcohol heavily.
• You have metabolic conditions such as diabetes or obesity.

Simple blood work and imaging can reveal early liver damage long before cancer develops. “If we do see that a patient has risk factors or early signs of damage, we can take steps to minimize someone’s risk of one day developing liver cancer,” adds Dr. Villanueva Rodriguez. “The key is to know you have them.”